Sleep Problems as Prospective Predictors of Suicidal Ideation

While the association between suicide and sleep problems has been reported, the effect size and temporal directionality remain unclear. This study examined whether sleep problems prospectively predict suicidal ideation.

In 2022, a self-administered online questionnaire including the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-9, and the Suicidal Ideation Scale (SIS) was distributed to a stratified random sample from a web survey panel and to local city government officers. The same questionnaire was administered again after 3 months. Cross-lagged model analyses were conducted to assess temporal and directional associations.

A total of 652 participants (mean age, 49.7 years) provided valid responses at both time points. Weak suicidal ideation was observed in 25.2% of participants, and moderate-to-strong ideation in 3.7% (SIS Q1: "wish to die"). Sleep disturbance (PSQI ≥ 6) was observed in 32.8% of participants. Cross-lagged analyses showed that PSQI global score and sleep latency prospectively predicted suicidal ideation. These associations remained significant after adjusting for depressive symptoms. Bidirectional associations between sleep disturbance and suicidal ideation were also observed. The presence of sleep disturbance predicted future suicidal ideation in univariate analysis (OR = 3.97) and remained significant in the PHQ-9-adjusted model (OR = 1.59).

Sleep problems were identified as prospective predictors of suicidal ideation. Sleep disturbances may represent modifiable targets for intervention in suicide prevention.